Why Aren’t People Who Need Weight Loss Drugs Getting Them?

Weight loss medications such as Ozempic, Wegovy, and Mounjaro have attracted widespread attention, making headlines across pop culture and scientific sectors alike. But it appears that hearing about these medications is a lot easier than actually getting them.

Using electronic health records from across 280 health care systems in the United States, Yale researchers discovered that only 3% of eligible adults have received a prescription for these weight loss medications. Their findings were published in the Journal of the American Medical Association on April 29.

“These medications have gotten lots of attention from the media because of how effective they are, not just for weight loss, but also for improving overall cardiovascular health,” says Yuan Lu, ScD, assistant professor of medicine (cardiology) at Yale School of Medicine (YSM) and senior author of the study. “But we wanted to ask who is actually getting these prescriptions? Are there any gaps or disparities?

“Turns out, very few people who could benefit from these drugs are actually getting them,” Lu adds. “We have a powerful new treatment here, but it is not reaching everyone who needs it.”

Using a nationwide dataset maintained by the medical record company Epic, Lu and her team gathered information on almost 40 million adults collected between 2020 and 2024 and analyzed how prescribing trends for semaglutides (which include brands such as Ozempic and Wegovy) and terzepatides (which include Mounjaro) varied with race, ethnicity, social vulnerability, and whether patients lived in an urban or rural area.

Even among the 3% of eligible adults who were receiving semaglutide and tirzepatide prescriptions, there were a number of differences. Men were less likely to receive prescriptions than women, and people living in rural areas or in communities with more socioeconomic challenges were also less likely to receive prescriptions. Black, Hispanic, and Asian patients were all less likely to receive prescriptions than white patients, differences which persisted across the entire three-year period.

This is especially concerning given that Black and Hispanic patients have higher prevalences of obesity in the United States compared with white patients.

“Some of these minority populations bear the biggest burden of obesity,” says Lu, who is also an assistant professor of biomedical informatics and data science at YSM and of chronic disease epidemiology at Yale School of Public Health. “However, many of these patients may be less likely to be seen by specialists who can prescribe for these medications, or even when they are being seen by these specialists, they may be less likely to receive prescriptions due to factors such as cost and insurance coverage.”

Lu suspects gaps could be even greater than what the study estimates. The data only reflect prescriptions documented in medical records and do not account for whether the patients actually filled those prescriptions.

Without insurance, semaglutide and tirzepatide medications can cost about $1,000 a month or more. Even for those with insurance, these medications are not widely covered, and insurance programs such as Medicare and Medicaid are prohibited from covering them when prescribed only for weight loss.

“Even if patients receive a prescription, they may not fill it in the pharmacy because of inadequate insurance coverage and high out-of-pocket cost,” Lu says. “There are many factors related to social determinants of health contributing to these differences.”

These low prescription rates and prescription differences are concerning because of the benefits these drugs could provide for millions of Americans.

Studies have shown that semaglutides and tirzepatides are not only effective for weight loss, but can also lower cardiovascular risk factors such as blood pressure, cholesterol, and glucose, and can reduce the risk of heart attack, stroke, and cardiovascular death. The protective effects of these drugs are so striking that, given current evidence, Lu believes the benefits outweigh potential negative side effects that the drugs might confer, such as nausea, vomiting, and stomach pain.

Lu is already working on investigating these prescribing trends further, comparing the real-world benefits of these weight loss medications to clinical trials, and looking at prescription rates in different subgroups such as patients with heart failure and severe obesity.

“The overall takeaway is that we have effective medications for obesity, but the uptake is very slow, and we have a long way to go to ensure that the effective treatments are available to everyone who needs them,” Lu says. “There are some subgroups left behind, and there’s effort needed to address that.”

Other Yale co-authors include Chungsoo Kim, PharmD, PhD; Joseph S. Ross, MD; Ania M. Jastreboff, MD, PhD; Daniella Meeker, PhD; and Harlan M. Krumholz, MD.